HIV/AIDS epidemiology in Poland. Late presentation of HIV infection & AIDS

HIV/AIDS epidemiology in Poland. Late presentation of HIV infection & AIDS Magdalena Leszczyszyn-Pynka Department of Infectious Diseases, Hepatology and Acquired Immunodeficiences Pomeranian Medical University in Szczecin Potsdam, 20.11. 2013

HIV i AIDS in Europie 1-2001 r. ~ 1,6 mln infected - 2011 r. ~ 2,3 mln infected - ~ 50% do not know about the infection - ~ 50% are co-infected with HCV 1 www.euro.who.int

FACTS 1. HIV pozwala dożyć średniej wieku swojej płci w swoim kraju 2. Zakażenie jest BEZOBJAWOWE przez średnio 10 lat 3. DIAGNOSIS of HIV infection in Europe in > 50% cases in pts with AIDS 4. globally HIV is the major cause of mortality among women of reproductive age and was responsible for the death of 280 000 children in 2008 1.Bhavan KP i wsp. Curr HIV/AIDS Rep 2008; 5: 150-8., 2. EACS 05, PE18.4/7, 3. Mack KA i wsp.jaids 2003 4. WHO HIV/AIDS Strategy for 2011-2015. 63 WHA, 21 May 2010, document UNAIDS/09.13E

Doświadczenia własne (Our own experiences) PONAD 50% NOWO WYKRYTYCH ZAKAŻEŃ HIV = DIAGNOZA AIDS Bander D. i wsp., PÓŹNE WYKRYWANIE AIDS MATERIALE WŁASNYM (2009, Przeg. Epidem.) W

Poland 31 Aug 2013 17 084 polish citizens confirmed HIV inf. 2948 AIDS cases (CDC/WHO def) 1220 AIDS deaths 25% - women, 75% - men ~ 35-40 % - HIV/HCV Source: Department of Epidemiology National Institute of Public Health National Institute of Hygiene (NIZP PZH) http://www.pzh.gov.pl/oldpage/epimeld/hiv_aids/index.htm

HIV cases, AIDS cases, AIDS deaths - 1996-2012 http://www.pzh.gov.pl/oldpage/epimeld/hiv_aids/index.htm

HIV in Poland new diagnosis 1.01.2013.-31.08.2013. 771 2012 1019 2011 1302 2010-1207 http://www.pzh.gov.pl/oldpage/epimeld/hiv_aids/index.htm

Annual HIV infections incidence - cases/100 000 citizens (mean for 2008-2012) We are here http://www.pzh.gov.pl/oldpage/epimeld/hiv_aids/index.htm

Annual AIDS cases incidence - cases/100 000 citizens (mean for 2008-2012) http://www.pzh.gov.pl/oldpage/epimeld/hiv_aids/index.htm

AIDS cases 2008-2012 route of the transmission??? MSM Ht sex IDUs http://www.pzh.gov.pl/oldpage/epimeld/hiv_aids/index.htm

wsse-poznan.pl Polska

Definitions 1. Late presentation: persons presenting for care with a CD4 count below 350 cells/µl or presenting with an AIDS-defining event, regardless of the CD4 cell count. 2. Presentation with advanced HIV disease: persons presenting for care with a CD4 count below 200 cells/µl or presenting with an AIDS-defining event, regardless of the CD4 cell count. Antinori A et al for the European Late Presenter Consensus working group, HIV Medicine (2010) DOI: 10.1111/j.1468-1293.2010.00857.x

HIV in Szczecin new patients 2011-2013* 2011 2012 (mean age) 2013 (till 19.11.13) % 50 + % LATE PRESEN- TERS DEATHS MEN 114 (34,1 ys) = 77,6% 41 (34,8 ys) 36 (37,3 ys) 37 (31,3 ys) 13/114 = 11,4 % 72/114 = 63,2% 6(5,3%) WOMEN 33 (44,9 ys) = 22,4% 6 (45,6 ys) 14 (36,8 ys) 13 (51,5 ys) 10/33 = 30,3 % 24/33 = 72,7% 4 (12,1%) ALL 147 (36,3 ys) 47 (36,1 ys) 50 (37,2 ys) 50 (35,3 ys) 23/147 = 15,6 % 96/147 = 65,3 % 10 (6,9%) 8 - AIDS Data on records, PNNI, Szczecin

HIV in Szczecin new patients 2011-2013* 15/147 = 10,2 % cases of syphilis solely men (13 MSM) 29/147 = 19,7 % HIV/HCV (tends to be lower than earlier) Only 2 cases of acute Hep C Data on records, PNNI, Szczecin

Syphilis in Poland 2011 2012 congenital 14 (3,6/100 000 births) 32 (8,28/100 000 births) early sy 655 (1,7/100 000) 677(1,76/100 000) late sy 286 (0,74/100 000) 284(0,74/100 000) Infectious diseases and poisonings in Poland in 2012, Warszawa 2013 National Institute of Public Health National Institute of Hygiene Department of Epidemiology Chief Sanitary Inspectorate Department for Communicable Disease and Infection Prevention and Control

Annual HIV infections incidence - cases/100 000 citizens (mean for 2008-2012) Syphilis incidence 2011-2012 1,82-4,61/100 000 West Pomerania 1,22/100 000 http://www.pzh.gov.pl/oldpage/epimeld/hiv_aids/index.htm

1069 records HIV in Szczecin 664 patients under care (at least 1 visit during last 12 mth) migration, treated in other centers, no need to be checked, lost of follow up ~ 10% 41% - HIV/HCV 38 % - IDUs Methadone programme full access (still not in all cities in Poland!)

HIV in Szczecin cont. MTCT Szczecin when all preventic procedures vertical transmission of HIV 0,0 (1995-2013 211 pregnancies) MTCT of HIV 9 cases 8 not tested in pregnancy 1 no prophylaxis with ARV (parents decision)

Ciąża a testowanie w kierunku zakażenia HIV 2 x tj. do 10 Hbd oraz 33-37 Hbd Less than 20% pregnant women are tested for HIV in Poland! Despite of being mandatory!

Polish patients on ART: 1.X.2013. - 7004 adults, - 118 children & adolescents < 18 ys of age - If recommended start (Zalecenia PTN AIDS 2013 + Krajowy Program Zapobiegania HIV/AIDS 2012-2016) http://www.aids.gov.pl

Pacjenci leczeni ARV w grupie 50+ Na dzień 10.06.2013 r. było 1052 osób leczonych ARV w wieku 50+ = to 15,66% wszystkich leczonych (6717) Z tego liczbowo i procentowo dla pacjentów 50+: 1. Kobiety: 195 = 18,54 % (1595/ 23,75% wszystkie kobiety) 2. Mężczyźni: 857 = 81,46 % (5122 / 76,25% wszyscy mężczyźni) Courtesy: dr Beata Zawada, National AIDS Centre, Vistula 2013

Local efforts: post-graduate & continuus education 1. Family doctors 2. Internal medicins residents 3. Gin/obstetr., dermatology, - Case studies presentations interdisciplinary meetings

CONCLUSIONS Stable situation of new diagnosis Still late diagnosis Focus on 50+ Insufficient HIV testing in pregnancy and among heterosexual population at any age Underestimation of STDs?

Special thanks to: Małgorzata Kłys-Rachwalska, MSc, Miłosz Parczewski, MD, PhD Katarzyna Maciejewska, MD